UNC Global Women’s Health at the 21st International AIDS Conference

The conference is an important international platform for policymakers, scientists and civil society groups to come together to deliberate progress and pitfalls in the fight against HIV.

A report from the Global Women’s Health Division:

The UNC OB-GYN Division of Global Women’s Health (GWH) was well-represented at the 21st International AIDS Conference this year, as two faculty and two fellows from the division attended to present five different posters and one article at the meeting, which took place in Durban, South Africa from July 18-22, 2016.

The conference, held biennially, is an important international platform for policymakers, scientists and civil society groups to come together to deliberate progress and pitfalls in the fight against HIV. This year’s theme was Access Equity Rights Now and included over 15,000 participants from 153 countries.

Our Zambia/South Africa team presented two posters and an article. The article was published by GWH Fellow Dr. Catherine Ford and GWH faculty members Dr. Carla Chibwesha and Dr. Jeff Stringer, division chief, and focused on their study protocol for a randomized clinical trial testing the field effectiveness of point-of-care technology to identify HIV-infected infants in Zambia. The article was published in a special issue of the Journal of the Acquired Immune Deficiency Syndrome (JAIDS), released to coincide with the AIDS conference.

Dr. Chibwesha also presented findings from her study on the comparison of self-collected and provider-collected samples for HPV testing in South Africa using a new point-of-care test platform known as GeneXpert. Dr. Chibwesha and her colleagues from Cornell and the University of the Witwatersrand in Johannesburg found that there was robust agreement between self- and provider-collected specimens tested for HPV using the XpertHPV assay and confirmed a role for self-collected samples in so-called “HPV test-and-treat” approaches to cervical cancer prevention.

Finally, GWH fellow Dr. Joni Price presented the results of a cost-effectiveness analysis that considered the costs and health effects of providing daily pre-exposure prophylaxis (PrEP) to reduce the high risk of HIV infection faced by pregnant and breastfeeding women in sub-Saharan Africa. She and her co-authors (including GWH faculty Dr. Stringer and Dr. Benjamin Chi) showed that a strategy of PrEP during pregnancy and breastfeeding is likely cost-effective and could be a promising addition to comprehensive prevention programs. These findings were also published in the special issue of JAIDS.

Our Malawi team presented three posters. The first was co-authored by GWH faculty Dr. Lameck Chinula and Dr. Jennifer Tang and presented the results from a randomized controlled trial of 73 HIV-infected Malawian women who were randomized to receive either the DMPA contraceptive injectable or the Jadelle® contraceptive implant, two of the most commonly-used hormonal contraceptives in Sub-Saharan Africa. There has been concern that hormonal contraceptives could increase HIV female-to-male transmission, but their study found that there was no difference in HIV genital tract shedding before or after initiation of the two contraceptives.

Dr. Tang also had two posters presenting analyses from a cross-sectional study of 308 HIV-infected women and 254 HIV-infected men attending antiretroviral clinic (ART) clinics in Lilongwe, Malawi. These analyses were done with Dr. Jamie Krashin, a fellow in the Division of Family Planning at UNC OB-GYN, who completed her international elective with Dr. Tang in Malawi in 2015. The first analysis found that being able to refuse sex without condoms was the stronger predictor of both consistent condom use and condom use at last coitus and that neither ART nor contraceptive use deterred condom use. The second analysis showed that one third of study participants still desired more children and that desire for more children was associated with having a partner who wanted more children, having fewer living children, and believing that pregnancy could be healthy for an HIV-infected woman.